Bone metastases in HCC are very rare and aggressive. Due to its rarity, optimal treatment strategies are not well defined. Early diagnosis is important for optimal therapy and improved survival.

We present an unusual case of myeloid sarcoma with ascites and abdominal pain in which initial clinical, laboratory, and imaging studies suggested a gastrointestinal malignancy or lymphoma. Subsequent detection of leukemic ascites and blasts in a gastric, small bowel, and skin biopsy supported a diagnosis of myeloid sarcoma. Bone marrow biopsy revealed 15% blasts, and cytogenetics with an inversion 16 rearrangement was diagnostic of acute myeloid leukemia (AML). Positron emission tomography-computed tomography performed at presentation to stage a presumptive lymphoma found later utility in following the burden of extramedullary disease. Standard AML induction chemotherapy resulted in complete remission and was followed by three rounds of high dose cytarabine consolidation. The patient unfortunately relapsed leading to re-induction followed by allogeneic stem cell transplantation. This report describes the presentation, assessment, and management of myeloid sarcoma.

A 74-year-old white male was diagnosed with squamous cell carcinoma in 2013. Six months after Mohs surgery, he underwent a left superficial parotidectomy, left neck dissection, and excision of the left postauricular lymph node after confirmation of lymphatic spread. Pathology from the left parietal scalp lesion revealed multifocal invasive squamous cell carcinoma. Extranodal tumor extension was noted in a postauricular lymph node and left parotid gland, and he was diagnosed with stage IV squamous cell carcinoma.Despite receiving adjuvant radiation therapy from December 2013 to March 2014 to the right neck and scalp, a skin graft after 5 months was confirmed to have squamous cell carcinoma. Positron emission tomography-computed tomography showed metastatic disease at the level of cricoarytenoid cartilage and bilateral parotid glands. Cetuximab was discontinued, as he had an anaphylaxis episode after the first dose, and he later underwent localized radiation to his left temple.He returned after a year with multiple cutaneous nodular masses over the left face and neck, with a large ulcerated necrotic area over the left temporal region (Figure). Due to the lack of further chemotherapy options, he was started on pembrolizumab.Anti-programmed death ligand 1 testing from the tumor showed a staining distribution of 1%-24% and a staining intensity of 1þ, with a low positive result. Next-generation sequencing assay showed genomic alterations in AKT3 E17K,

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Hepatocellular carcinoma (hcc) arising from a hepatic adenoma is a rare phenomenon accounting for fewer than 5% of hcc cases; it seldom recurs after resection of the primary tumour. We report a case of extrahepatic metastasis of hcc arising from a hepatic adenoma that presented as a solitary sternal metastasis without any evidence of intrahepatic recurrence.Our patient was initially treated with radiation therapy and bland embolization, without response. Subsequently, the patient developed progressive disease while taking sorafenib. He later received chemotherapy with docetaxel and gemcitabine, with the development of multiple pulmonary and splenic nodules. However, he remained free of intrahepatic recurrence. To the best of our knowledge, this is the first case of extrahepatic metastasis of hcc arising from a hepatic adenoma without evidence of intrahepatic recurrence.

115 Background: The elderly population is the fastest growing segment of the US population, and it is widely affected by cancer and its related sequelae. At St. Louis University (SLU), a simple Rapid Geriatric Assessment (RGA) was developed based on the SLU Mental Status Exam (SLUMS). The RGA includes screening for frailty, sarcopenia, nutrition, and cognition. In this pilot study, we used RGA to assess geriatric patients with newly diagnosed malignancy prior to cancer therapy and its ability to improve outcomes in oncology patients. Methods: Elderly patients (aged 65 and above) with newly diagnosed malignancy completed the RGA either inpatient or outpatient at SLU. A retrospective chart review was done to collect patient's demographics, type of malignancy, number of hospitalizations since diagnosis and referral to palliative care over a 6 month period. Relationship between tolerability and RGA subscores were assessed using general linear models, Kaplan-Meier survival analysis and Chi-square testing. Results: Twenty six patients (mean age 76 [65-90]) were included from December 2015 to 2016 of which 9 were male (n = 35) and 17 female (n = 65). 19 patients (73%) were inpatient, 7 (27%) were outpatient and 13 patients (50%) received chemotherapy. Using the Mann-Whitney U test, no significant difference was seen between RGA subscores (FRAIL p = 1; SNAQ p = 0.69; SARC-F p = 0.71; RCS p = 1) in patients receiving versus not receiving chemotherapy. There was no significant difference in overall survival (OS) over a 20 month period based on chemotherapy status (p = 0.39). In our study, 62% of patients (n = 16) were referred to palliative care and noted to have a significant better OS (p = 0.04). Conclusions: The RGA is a self-explanatory tool that can be used in geriatric oncology patients and it can bedone in 10 minutes. In this pilot study, we used this tool in a small number of patients. We plan to perform a prospective study to evaluate the RGA comparing to ECOG-performance status in geriatric patients prior to standard cancer therapies. Improvement of overall survival with incorporation of palliative care in oncology patients is reaffirmed in our study.

(HR) 1.77, 95% confidence interval (CI) 0.14 e 2.76, p ¼ 0.012] and high / very high rDRI (HR 1.79, 95% CI 1.22 e 2.63, p ¼ 0.003) were independently associated with OS. Differences in overall survival were reflected in higher risk of relapse for recipients of minor ABO compatible donors, adjusted forrDRI (HR 2.00, 95% CI 1.28 e 3.54, p ¼ 0.018). PBSC recipients were then analysed separately to investigate a possible effect of graft processing on survival. Recipients of plasma depleted PBSC grafts had a higher risk of mortality on univariate analysis (p ¼ 0.038), and on multivariate analysis adjusted for rDRI (HR 1.68, 95%CI 1.09 e 2.58, p ¼ 0.018), although not when also adjusted for ABO compatibility (HR 1.71, 95% CI 0.74 e 3.98, p ¼ 0.212). Differences in survival and relapse according to ABO compatibility may reflect manipulation of the graft prior to infusion with subsequent effects on T-cell numbers or function. In this study population, it is difficult to differentiate the effects of graft processing from ABO compatibility as the two were closely linked. Alternatively, the presence of minor ABO mismatch may modify immune restoration in vivo and alter graft-vs-malignancy effect. These results warrant replication and further investigation to determine whether ABO incompatibility influences outcome of allogeneic HSCT and the mechanism by which this occurs.

Introduction: Hematopoietic stem cell transplantation (HSCT) requires resource intensive care. Myeloablative conditioning regimens used prior to HSCT tend to be more intensive than other preparative regimens, and may therefore be more costly. Objective: To estimate total 100-day and one-year costs of inpatient HSCT, stratified by conditioning regimen and other potential contributors of cost. Methods: We used a retrospective cohort from MarketScan claims database to analyze costs among autologous (auto) or allogeneic (allo) inpatient HSCT patients between 1/2/2010 and 9/23/2013, and developed an algorithm with clinical expert opinion to determine, based on what we could see in claims, whether conditioning was myeloablative (MA) or nonmyeloablative/reduced intensity (NMA/RIC). Using the date of HSCT as the index, we examined healthcare use and costs within 100 days and one year of follow-up, according to graft type, conditioning regimen, and age group (pediatric age <18 years). Results: We identified 1,564 patients with inpatient HSCT for whom graft type and conditioning regimen were determinable (MA allo: n¼398; NMA/RIC allo: n¼195; MA auto: n¼969; NMA/RIC auto: n¼2). Our sample was 93% adult and 61% male. The most common indications for HSCT were lymphoma (62.4%), aplastic anemia (46.3%), acute lymphocytic leukemia (21.5%), and acute myeloid leukemia (11.3%) (not mutually exclusive). In the first 100 days after HSCT, median total healthcare costs were $289,283 for MA allo patients vs. $253,467 for NMA/RIC allo patients and $140,792 for MA auto patients. Mean length of stay (LOS) for the index HSCT hospitalization was 35.6 days for MA allo patients, 26.6 days for NMA/RIC allo patients, and 21.8 days for MA auto patients. Subsequent hospitalization occurred for 42.5% of MA allo patients with a mean LOS of 9 days vs. 43.6% of NMA/RIC allo patients with 11 days and 20.8% of MA auto patients with 6.5 days.